Basic Information
| Provider Information | |||||||||
| NPI: | 1831612035 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | MINA GAMAL NASR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 WELLS ST | ||||||||
| Address2: | |||||||||
| City: | WESTERLY | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028912922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602714364 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25 WELLS ST | ||||||||
| Address2: | |||||||||
| City: | WESTERLY | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028912922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602714364 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2017 | ||||||||
| LastUpdateDate: | 07/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | MD16997 | RI | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.